Around the world, one woman every minute is infected with HIV and the leading cause of death among women in the reproductive age group is AIDS. “India has a low prevalence of HIV/AIDS of 0.34% but as a heavily populated country, this ranks as the third largest number of people living with HIV in the world” (Mothi, Lala, and Tappuni, 2015). HIV stands for Human Immunodeficiency Virus, it attacks cells that are important to the human body in regards to fighting off diseases or infections and destroys them. HIV is spread through specific bodily fluids and has three stages. If untreated or unaddressed, HIV will progress through all three of these stages. In the first stage a person experiences flu-like symptoms, then the HIV will slow down reproduction and not cause any symptoms, and in the last stage turn into AIDS. AIDS is the final stage and most people normally do not survive longer than three years without treatment, their immune system is severely compromised and the are susceptible to many different types of illnesses. In studies done in India, unprotected sexual intercourse between a man and women is cause for more than 87% of new infections of HIV in India. In my final post, I will explore the advantages of educating all people in India in hopes of reducing the spread of HIV in India and the advantages of using an epidemiological theory when studying this issue. I will also explore the social, cultural, and economical determinants that influence the spread of HIV and the obstacles women face everyday in contracting HIV and living full, healthy, abuse-free lives such as equality and poverty. I will first start out by talking about the determinants that cause women to struggle to live healthy lives.
A big struggle in India is equality between men and women and I believe that this is a major social and cultural determinant that contributes to the high rate of HIV among women. In India, there is still a huge gap to overcome in the way women are treated in comparison to men. If you ask me how women and girls are treated in India, I would say not very well. This is very easy for me to say because I am accustomed to they way women are treated here in the US. Although, to some of those who call India home, they might say that the treatment is normal and even expected. In an article on ireport.cnn.com by Meera Vijayann, The Secrets of the ‘Modern’ Indian Woman, she documents the struggles she has encountered and overcome as a young woman in India. Meera first starts off by talking about how she was violated at the young age of nine by her teacher who was in his twenties. She also talks about a time where a girl at her college was “attacked” by a man at their bus stop and instead of helping her file a complaint or enforce laws to further protect the female students, the college enforced a dress code for women. There are many instances of men publicly and blatantly staring at and touching women inappropriately, because they feel as though it is “their right” to do so. (Meera Vijayann, 2013). Nobody ever has “rights” over another person and because some women are seen more as property in India, I feel as though this makes some people think that it is okay to physically or sexually abuse women. Since this happens so much, it is not surprising to me to see that so many women struggle with HIV in India. Like stated above most infections of HIV in women are caused by sexual abuse. We should also keep in mind that HIV is not just a problem women face but men as well. A study done in Mumbai, India even shows women are be silenced because of the power imbalance between genders and this leads to a culture of silence when it comes to women’s sexuality. Women can be more apt to stay in a relationship that is abusive or one where they are at risk of developing HIV because it is hard for them to due to the cultural and social systems/beliefs in place and leaving the relationship can have great economic consequences (Ramasundaram, .S., 2002).
Poverty is also a huge determinant that contributes to the high abuse rate and then in turn the spread of HIV in India. Women who have low economical and social status are at a big disadvantage because men are seen to have “power” over them. Because men are seen as dominant to women, this gives women less power to negotiate the use of a condom (a very big prevention method for HIV) or even give consent to the sexual act at all (Mothi, Lala, and Tappuni, 2015). This is what predisposes women to HIV and leaves most women at risk for developing the illness. In India, those who are in poverty and have a lack of education are also linked to a higher rate of STI’s and have a higher abuse rate than those who are not in poverty (although, this is not to say that those women who come from wealth do not experience this issue too!). Abuse rates in India are dependant on the region. A study was done, and in five different districts of Utter Pradesh (one of the least developed states in India) it was concluded that more than six in ten men who have admitted to abusing their wives have done so repeatedly. In this same study it was found that men who have little education are more apt to abuse their wives as well. Men with five years of education or less were more likely to abuse than men who had more than five years of education, with an odds ratio of 2.1-3.3. Extreme poverty also seemed to correlate with higher rates of abuse in three of the five regions of Utter Pradesh. When abused, 40-90% of women responded by crying and only 7-42% responded by yelling back, 4-10% ran away, and 0-6% retaliated. Even more shocking was that no more than 3% of women were reported to seek out medical treatment after being abused (Gerstein, 2000). This to me is not just surprising, but saddens me to hear that 97% of women or more just give up and do not even attempt to seek medical care. Poverty and abuse should be huge concerns to India because these are factors that are not only detrimental to the lives of women but also help the spread of HIV and STI’s in India.
I have also chosen to use the epidemiological theory to research and examine the rise of HIV in women across India. I believe that using this approach would be most helpful because “Anthropologists and epidemiologists interests have sung the praises of collaborative research, especially that focusing on the health consequences of human behavior.” (Inhorn, 1995). In India, due to the poverty and high rate of abuse of women, this has helped to make it possible for aids to become a big health issue within the country among women. To further understand this issue, we can not just use a solely anthropological approach, which is where epidemiological theory comes into play – allowing us to examine this from both an anthropological and epidemiological perspective. The aids epidemic in India and the high rate of violence against women can not be examined only using a strictly medical or epidemiological approach. The spread of aids is a health consequence of human behaviour in India, which is exactly what anthropology and epidemiology can aim to interpret.
To break down the two, epidemiology is used to look at and identify the factors within an illness, it is defined as “the study of the distributions and determinants of diseases and illnesses within a human population.”. Epidemiology is more disease oriented and is “viewed by most anthropologists as a Western biomedical construct”. As a subdiscipline of medicine, it is a public health specialty taught at master’s and doctoral levels. It looks to identify the relationship of behavior to a particular disease (in this case HIV) and why the diseases are spreading in the way they are. Using an epidemiological approach will be very helpful in assessing the spread of aids in India, because this will help us to answer the questions of how we can fight off this illness and how we can combat the spread of it (Inhorn, 1995). Epidemiology seeks to ask the question How can we get rid of this problem?” at the population level, not an individual level (Riley, 2015). While anthropology focuses on the social and cultural aspects of the behavior and how they correlate to each other. “Anthropologists study ‘illness’ which encompass the cultural meaning and social relationships experienced by the patient.” (Inhorn, 1995). Anthropology also looks at the spread of the disease and the causes of it on a macro-level, which compliments epidemiology since epidemiology looks at it on a smaller level. It is important to keep in mind though, that epidemiology and anthropology do not go together hand in hand, they are both very different ways of looking at the spread of disease and illnesses and they each look at different aspects of the spread of disease in that culture (Dunn & Janes, 1986). Both medical anthropology and epidemiology are similar in the sense though, because they both operate within their own sphere, peripheral to biomedicine and this is what unites them. (Inhorn, 1995).
If we could somehow provide education to young men and women at an early age, I feel as though this would help to deter the spread and prevalence of HIV in India’s near future. One big reason that this infection has the chance to spread as much as it does in India is because of the lack of knowledge of the illness, especially among the poor. I believe that we should educate the people of India using an anthropological and epidemiological perspective to explain to the what some of the factors that influence the spread of illnesses such as HIV are and how to stop spreading HIV. This could easily be done when children are in school, although this is a bigger issue than just educating the children, because of the high poverty in India, some children are unable to get an education and are deprived of many resources. Also, because of poverty, condoms (which help deter the spread of HIV and STI’s may not be readily available or people may not be willing to spend the money they could be spending on food or “necessities” on condoms. There are a lot of changes that need to be implemented and a lot of them need to happen at a large scale. The people of India need to reform their view of women and allow for them the same respect and care as men, which is not an easy thing to do because of the social, cultural, and economical determinants that I talked about above that influence the people of India and their views.
The spread of HIV and the prevalence of drug use in India should be a big concern to all of us because not only is this detrimental to the health of all people, especially women, but this is also an issue concerning the way women are treated in India. The way women are treated is a huge issue that needs to be addressed. If women felt as though they had more say in their life and more power, they would be able to say “no” to these men, push these men to use a means of protection when engaging in sex, or even leave abusive relationships which might lead to a decrease in the spread of HIV. Also, as I said earlier, examining this problem using an epidemiological theory allows us to be able to look at the person as well as the country as a whole and examine the specific symptoms of the illness, the biology of it and how it spreads as well as the practices and beliefs of the country that cause HIV to be such a prevalent issue in modern day India. The way women are not treated as equals, being seen as “property”, and the poverty in India are also huge social, cultural, and economical determinants that influence the spread of HIV. HIV is a very dangerous illness and awareness of HIV needs to keep being raised in countries like India, where not many people realize how dangerous it is. Along with the help of programs or other countries, hopefully the rate of infection can continue to decline.
Mothi, Lala, and Tappuni. “HIV/AIDS in Women and Children in India.”Wiley.com. John Wiley & Sons, 25 Apr. 2015. Web. 29 July 2016.
Vijayann, Meera. “The Secrets of the ‘Modern’ Indian Woman.” CNN IReport. CNN, 23 Aug. 2013. Web. 14 July 2016.
Ramasundaram, .S. 297-303. 2 How Men’s Power over Women Fuels the HIV Epidemic (n.d.): n. pag. Pubmedcentralcanada.com. Department of Commerce, 26 Jan. 2002. Web. 29 July 2016.
Gerstein, L. March, 2000. In India, Poverty and Lack of Education are Associated with Mens Physical and Sexual Abuse of Their Wives. 2. https://www.jstor.org/stable/2648290?seq=1#page_scan_tab_contents
Inhorn, Marcia. “Medical Anthropology and Epidemiology.” (n.d.): n. pag.Http://anthropology.msu.edu/. Elsevier Science Ltd., 1995. Web. 5 Aug. 2016.
Dunn, and Janes. “Introduction: Medical Anthropology and Epidemiology.”Springer Link. Springer Netherlands, 1986. Web. 05 Aug. 2016.
Riley, Emily. “Introducing Theory 1: Epidemiological Theory.” ANP 270 Women and Health. N.p., 13 May 2015. Web. 16 Aug. 2016.